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Wednesday, December 11, 2013
Questions About Hyperthyroidism
I am a 44 year old female from India (Asia). For the past 10 years I have been suffering from heart palpitations, hunger pangs, shortness of breath, fatigue with climbing but my liver function, CBC, kidney profile, lipid profile have always been normal. My thyroidp profile too was normal though the TSH was in the low normal range and the T3 and T4 in the highnormal range. However, my Glucose tolerance test results have always been abnormal.
The docs told me I could be heading for diabetes, but is is now more than 5 years since the latest GTT and I don`t have abnormal fasting sugars and hence no diabetes. Only recently I insisted on another thyroid profile and the report comes back as 0.03 TSH (NORMAL RANGE BEING 0.30-5.5) T3 at 215 (normal range being 60-200) T4 at 14 (normal range being 4.5-12.0). Now I am going for a nuclear thyroid scan and antithyroid antibodies.
My qustions is had I actually been suffering from Hyperthyroidism the last 10 years wihtout showing up in the thyroid profile? Only now since it has shown up as low TSH the docs believe I have something more than anxiety.
Next I am afraid of thyroid storm. What should I do take precautions against it? I don`t want to take radioactive iodine therapy because thyroid storms have been noticed after this therapy or even after treatment of hyerthyroidism
Would I eventually become hypothyroid?
Does stress cause hyperthyroidism too? Then would that be resolving thyroiditis? My sister was recently diagnosed with resolving thyroiditis after some stress she underwent.
I will get back to you about the results of my nuclear thyroid uptake and my antithyrid antibodies too.
- Had I actually been suffering from Hyperthyroidism the last 10 years without showing up in the thyroid profile?
No. Your previous thyroid tests were normal. You were not hyperthyroid then.
- What should I do take precautions against thyroid storm?
Thyroid storm under these circumstances would be extremely, extremely unlikely - not impossible, but extremely unlikely. All of the treatments for hyperthyroidism (anti-thyroid drugs, radioactive iodine, and surgery) are very safe and effective. However, each treatment for hyperthyroidism has rarely been reported to cause a bad reaction of one kind or another. Leaving the hyperthyroidism untreated is more likely to cause you medical problems that accepting one of the treatments available despite the rare bad reactions.
- Would I eventually become hypothyroid?
Most likely yes. However, the treatment for hypothyroidism (namely thyroid hormone pills) is cheap, easy to take, and essentially without side effects.
- Does stress cause hyperthyroidism too?
There have been studies suggesting that Graves' Disease may sometimes be precipitated by a major stress, but this has been difficult to prove conclusively. I am not aware of any association between stress and either subacute or painless thyroiditis, though subacute thyroiditis often follows a viral illness and painless thyroiditis can occur after delivering a baby.
Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University